Nurses argue both sides of Question 1

It was a no-show for ‘No’ on Questions 2 or 3 in the Nov. 6 election, so only ballot Question 1 about nurse staffing had anything close to a showdown at the Franklin County Chamber of Commerce breakfast meeting Friday.

The proposed Nurse-to-Patient Limit law, with nurses staking out positions on both sides, got the attention of the roughly 100 chamber members attending their monthly meeting of their organization, which has taken no position on the ballot questions.

(A fourth question, a non-binding referendum appearing on the ballot in most Franklin County towns, would instruct the area legislators to vote to create a single-payer health-care system in the state. It was not addressed at the meeting.)

Suzanne Love of the Committee to Ensure Safe Patient Care represented the ‘Yes on 1’ position, while Ashley Mancini of the Coalition to Ensure Safe Patient Care spoke on behalf of the ‘No on 1’ perspective.

Love, a union nurse at Baystate Franklin Medical Center, and Mancini, a telemetry clinical manager at Cooley Dickinson Hospital in Northampton, both emphasized that as nurses, they care about patient safety.

Question 1, brought by the Massachusetts Nurses Association and opposed by hospitals, including Baystate Franklin and Cooley Dickinson, would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals, according to the Secretary of State’s Office.

“If you’re admitted, you’re quite sick, and its quite complicated,” said Love. “You need a nurse who can provide the time and attention that you need. My job in the emergency room is to be the overseer of the complicated process of solving the mystery of why you’ve come. The best way to do that is for me to have the time to give you attention that you need.”

It takes time to administer and monitor reaction to medications, to monitor and address surgical wounds and to educate the patient and family about continuing to provide care at home.

In California, the only other state that has set legal limits that are now only in place in Massachusetts intensive care units, she said, there’s been a decrease in hospital re-admissions and in the overall cost of patient care.

“We can be a leader here, along with California,” Love said, “to improve patient outcomes with a better nurse-patient experience. This will improve patient outcomes; this will revive the kind of flexibility we need to provide the right kind patient care. … As an emergency-room nurse, when I have a critical care patient come in, the odds are that the one I already have will not do as well. The odds go up that somebody will have a medical error, that someone will face medical complications, the more patients that I have. It just makes sense.”

Yet Mancini, pointed out that the mandated staffing rules would provide nurses with less flexibility.

“If we had patients waiting in the emergency room and the nurse felt we were able to accept another patient outside of this rigid ratio, the nurse would be placed in an ethical dilemma,” the Cooley Dickinson nurse said . “Either we accept the patient and provide the amazing care that we know that we can provide, which would bind the hospital, or make the patient wait in the emergency room.”

The referendum calls for up to $25,000 fines if a hospital violates the mandatory staffing.

If the ballot question is approved, Cooley Dickinson — which she said currently has 20 open positions — would need to recruit 50 more nurses. She said of the initiative, does not account for staffing ratio differences on the night shift, when the workload is typically lighter as patients are usually sleeping.

“This is using extra valuable resources that could be used elsewhere,” said Mancini, adding that if not enough nurses can be recruited, “up to 300 mental health patients would be turned away, and an estimated 5,000 to 10,000 emergency room patients would not be able to receive care.

“As a nurse, I was taught to be flexible, adjust to change, and use my education and experience to make decisions to provide the highest quality of care to my patients,” said Mancini, adding that lives could be hurt by the proposed limits. “Question 1 would take all of that flexibility away. Nursing is unpredictable. Nurses need, our patients need us, to be flexible.”

Baystate Franklin estimates the ballot initiative would cause the Greenfield hospital to treat 40 percent fewer emergency visits, which works out to about 28 patients a day not having access to emergency services or experiencing extensive delays in the waiting room. The Committee to Ensure Safe Patient Care has rebutted those assertions.

The hospital said if approved, the limits would cost it $3.3 million a year, while a Boston College study touted by the nurses union, said Baystate Franklin was one of nine Massachusetts hospitals that would see no added costs.

Other questions

With no opponents for Questions 2 and 3 present, Chamber board Chairman Mark Abramson read summaries of the ‘no’ positions on the two ballot questions representing the views of the conservative Massachusetts Fiscal Alliance and Keep MA Safe on Questions 2 and 3, respectively, to balance the ‘yes’ positions of advocates from the organizations People Govern, Not Money and Freedom for All Massachusetts.

Friday’s meeting, which presented each of the ‘no’ positions before the ‘yes’ positions, included Janice Stone supporting Question 2, which would create a citizens commission to recommend a potential U.S.Constitution amendment limiting election spending and corporate rights.

“With yes on 2, Massachusetts is part of this strongly nonpartisan national effort to end the corrupting forces of big money in government,” said Stone, explaining that 19 states have already had resolutions supporting the issue but that the Bay State stands to be the first to consider a study. “Right now in our country, money, not the will of people, is the biggest factor in determining who gets elected and who holds power in America. This was not always the case, and we can change it.”

The Mass. Fiscal Alliance statement opposing the question said, “In the (Citizens United) decision, the (U.S. Supreme) court ruled to expand that freedom and apply it equally to all entities and organizations, rather than just the arbitrary list of winners and losers selected by elected officials in previous campaign finance laws.”

April Griffith endorsed a ‘Yes on 3” vote,” which would maintain protections on the basis of gender identity in the state’s public accommodation law against discrimination. Griffith said a ‘no’ victory would make Massachusetts the first state in the nation to extend these protections and then remove them.

“That would leave a large hole in the middle of New England,” Griffith said, “where every state has gender identity, defined as “a person’s sincerely held gender-related identity, appearance, or behavior, whether or not it is different from that traditionally associated with the person’s physiology or assigned sex at birth.”

Removing those protections with an argument that the law enables a sexual predator entering a locker room, dressing room or bathroom “hypercritically … harms a minority group without actually leaving anything to hinder sexual predators or protect sexual assault victims,” Griffith said.

The official statement from Keep MA Safe says, “The law violates the privacy and safety of women by allowing any man identifying as a woman, including convicted sex offenders, to share women’s facilities. Under the law, any attempt to block a man from entering the women’s locker room, dressing room, or bathroom could result in individual penalties of up to $50,000 and a year in prison. … No law should make women and girls feel unsafe and exploit their privacy and security.”